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HOSPITAL AND HEALTHCARE FACILITY DESIGN PDF

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This publication supersedes the Guidelines for Design and Construction of Hospital and Health Care Facilities,. edition. To order prepaid copies of the. A health care facility's new or improved design establishes the basis for safe This third edition of Planning, Design, and Construction of Health Care Facilities —developed in safely lit central garden space centrally located in a hospital. There are very few codes applicable to hospital design in India; you could count them .. are produced is very important to the healthcare facility design process.

In the traditional patient room style, called back-to-back, patient beds are on the same wall. Back-to-back plans create major transfer noise between rooms, and their use of the same oxygen, compressed room air, and suction intensifies the transfer noise and vibration.

In a truly standardized room, this does not occur. In addition, the walls between rooms are separated and insulated with airspace, minimizing transfer noise. This was designed into the structure early in the building design. In addition, vibration noise between floors and within a floor was minimized through design.

The mechanical, electrical, and plumbing systems were designed to use the optimum materials for minimizing noise. The flooring in the patient room is rubber, second to carpet in sound reduction qualities.

The reason carpet was not chosen it was mocked up and tested is because spills and mishaps needed to be cleaned up immediately. Carpet requires housekeeping to bring a carpet cleaner, which could take time and also could be embarrassing for the patient.

Carpet was chosen, however, for the alcoves and hallways, with a low-nap, special carpet for hospital application. Special ceiling tiles that absorb noise better than regular ceiling tiles were chosen.

Triple glazed windows were specified to minimize outside noises. No overhead paging system is used except for public emergencies such as a tornado warning , and nurse call systems use minimal tone with vibrating features. As specific equipment and technologies were needed, manufacturers of that piece of equipment or technology were contacted and asked how they reduced noise in their products.

Scalability, adaptability, flexibility Many design and construction concepts can be applied to achieve a scalable e. At St. Space around the bed is sized so procedures e.

Visibility of patients to staff The importance of being able to see patients is inherent to nursing care, a concept that was recognized early by Florence Nightingale, who advocated the design of open, long hospital wards to see all patients.

The design of units and patient rooms should allow caregivers to be in visual proximity to patients; a pod structure can allow close proximity and enable quality care by improving efficiency and effectiveness. The nurse can also check on the patient in the evening without opening the door and waking the patient. Each room is wired for cameras for observation.

All materials, such as medication, linens, IV poles, and a rough-in for icemakers, are delivered to the alcove to allow nurses to spend more time with the patient. The chart will initially be in the room, but shortly after the new hospital opens, it will be replaced by electronic medical records with a workspace so nurses and other caregivers can spend more time with the patient. Furthermore, visibility also means lighting to see the patient.

Natural light is maximized by large windows in every patient room. Light sources after hours are as close to natural light as can be achieved cost effectively. Canned lights are located over the patient for assessment. A total of 15 lights are located in every room, including the bathroom and alcoves. Involving patients in their care The IOM 9 found that many patients have expressed frustration with their inability to participate in decisionmaking, to obtain information they need, to be heard, and to participate in systems of care that are responsive to their needs.

The availability of information for patients increases their knowledge regarding their illness and treatment options, and being informed gives patients the opportunity to participate in shared decisionmaking with clinicians and may help patients better articulate their individual views and preferences. A couch folds outs into a bed; a desk with an Internet connection encourages family members or friends to stay with patients.

This is intended to help patients to be more active with their care and better able to protect themselves from errors. A portable computer on a cart same one used by staff is located in each room so patients can have appropriate access to their chart. Standardization Standardization has been documented as an important human factors-based design strategy 4 , 64 that can help lessen the number of errors.

Standardization reduces reliance on short-term memory and allows those unfamiliar with a specific process or design to use it safely. The patient rooms in St. The headwalls are standardized throughout the facility; a seven-drawer configuration was designed into every patient room or alcove to provide consistency of supply locations and to simplify the restocking of those supplies. This provides staff with a known constant, regardless of where they may be caring for a patient throughout the facility due to floating, a patient resuscitation, or some other emergent situation.

The electronic medical record, use of bar-coding, computerized provider order entry, and other technologies will be standardized eventually, assisting in the development of standardized protocols and order sets. The facility materials distribution and routine nurse functions can also be standardized to match the facility.

Equipment is not fully standardized yet, but that is the goal, since fully standardized equipment provides the highest level of safety.

The complexity and variety in equipment vendors and models is immense, and this complexity creates more errors. This weakness—the lack of equipment standardization—was pointed out continually in using failure and effects mode analysis.

So St. The hospital was able to purchase limited new patient monitoring equipment, and took care to assure that new and existing equipment were from the same vendor to give the user a similar feel and functionality, regardless of which equipment they were using.

The hospital will continue to utilize this process to guarantee long-term equipment standardization within the facility.

International Health Facility Guidelines

Automation where possible The IOM identified health information technology solutions as a necessary component to improving patient safety. These applications are intended to allow caregivers to give care more efficiently and rely less on short-term memory. Many design features and technology applications have affected multiple latent conditions. This was one of the important criteria used at the matrix exercise to determine which design features to include.

Technology applications were deemed to be a critical part of allowing St. Immediate accessibility of information, close to the point of service In order to provide patients with the most accurate diagnosis and treatment possible, clinicians need to have complete, real-time information about the patient, care needs, and treatment options.

Technologies such as the Internet, electronic medical records, and clinical decision-support systems can accomplish this. When the hospital opened, the patient chart was percent paper based. In traditional hospital environments, the patient chart changes location without regard to patient activities. Early mornings, a physician may come around and take the chart to a quiet dictation area to write notes and orders.

Patient Safety and Quality: An Evidence-Based Handbook for Nurses.

The chart is often left there until another care provider requires the chart. This was surprisingly effective and compliance was unusually high. The unit clerk then transcribes the order and does any necessary computer order entry in the alcove. The chart never leaves the alcove. Anecdotally, the physicians find this process useful to them. They can make rounds more efficiently, since they never have to look for a chart to write their notes or orders.

Verbal orders are also reduced.

Hospital and healthcare facility design pdf

For obvious reasons, this process will cease to be relevant when the electronic medical record is implemented. Minimizing fatigue Fatigue has been identified as a contributing factor to human error.

Other considerations in the design of St. Often these transfers involve handoffs, which, as described in another chapter in this book, also place the patient and clinician at risk for errors.

Minimizing patient transfers and handoffs has design implications. Private single rooms with appropriate space around the beds, lifts, and other safety mechanisms allow more procedures to be performed in the room. This is similar to the model in obstetrics with Labor Delivery Recovery Post-Partum LDRP rooms, where the mother delivers the child and the child can remain with the mother in the same room for the entire stay.

Another example is the physical therapy gym located on the med-surg unit—the patient never leaves the unit to obtain therapy, and their nurse is always in close proximity should a change in patient condition occur. Electronic medical records are another important tool. Bar-coding helps with continually and accurately identifying the patient.

These are all features that minimize infection. Air supply and return grates that need cleaning have been upgraded to stainless steel so cleaning is more effective. However, the most important design element is the location of the sink, since lack of hand washing is the number one reason for hospital-acquired infections. The two most common methods are jumping and hanging. Thus, St. To minimize jumping, windows cannot be opened, and they are triple-paned, making them much harder to break through.

If a suicide-risk patient is identified, that patient is transferred to the mental health unit, but increased visibility in all patient rooms helps staff keep a closer watch, which helps minimize the risk of suicides. Death of patients in restraints, patient falls St. The new beds ordered for the hospital have eliminated many of the risks of deaths due to restraints.

With less and less restraints, however, the risk of falls rises. Most patients fall at night or while walking with a nurse or other caregiver. Design elements that help reduce falls include fixed night lights in every room, beds that drop down to sixteen inches above the floor, locating the bathroom at the head of the bed with railings to the stool and shower, and utilizing bathroom lights that automatically turn on when anyone enters the bathroom.

Besides the above-mentioned strategies, a bed-exit system is being explored using infrared technology. If a patient is identified as he is trying to get out of bed, then lights could turn on, an emergency call to the pager could occur, or a voice could ask the patient to wait for a caregiver. Such a system is in design at St. Correct tube—correct connector—correct hole placement events, oxygen cylinder hazards All connectors are a different size for different gases and color-coded.

Storage and identification of portable gases employ the same identification program. All gases are in standardized locations to further minimize the risk of a gas-connecting error. Wrong-site surgery Operating room suites were standardized, using proper lighting and cable access to digital images and photographs of the surgery site. Medication and transfusion-related adverse events Bar-coding, unit doses at point of service, electronic medical records, and physician order entry are critical elements for medication error reduction.

Private rooms with alcoves that include medical records allow nurses to concentrate on one patient and document those efforts, before moving on to the next patient. Bringing It All Together at St. The patient room evolved over months of design. Over 27 different designs or refinements were made on the patient room. This room is not the only way a patient room can be designed for safety, but it is believed to be a good way, and it exhibits efficient, thoughtful features that meet National Learning Lab expectations.

The National Learning Lab had a powerful effect on St. The importance of nursing leadership in the whole process cannot be overstated. Without the commitment, knowledge, and perseverance of the nursing leadership, along with the chief executive officer, board, medical staff, architects, and the rest of the design teams, a safe design would not have occurred. The effort of St. The impact of the National Learning Lab recommendations on processes also offers an immense opportunity to improve the safety of patients in hospitals.

The work of St. The building of the new hospital was completed in , and investigators are currently evaluating the impact of their designs on the frequency of adverse events and patient outcomes. Using innovative architectural and design features to enhance patient safety together with institutionalizing a nonpunitive safety culture can potentially have a greater impact than design features alone.

Over the past few years, the National Learning Lab changed St. Leaders and clinicians at St. This should lead to less human error and potential harm and more efficient operations process. Yet, one of the major difficulties of translating this efficiency and better outcomes into improved net income is the basic misalignment of financial incentives.

Both the fee-for-service and the DRG diagnosis-related group introduce perverse incentives. Hospital revenues can actually be reduced as a result of improved safety, and savings can accrue to the insurance companies and not the institutions creating the improvements. Although there is some evidence of changes to improve these misaligned incentives, more dramatic changes are needed to encourage safe process redesign. Practice Implications The evidence base is growing in support of evidence-based design for renovations and new building.

The new field of evidence-based design has emerged at a time when there is a health care construction boom. Based on the Gurses and Carayon study, 54 care processes will need to be modified to address inefficiencies caused by distractions e.

Lessons learned should be shared with others to enable improvements across the country, not just on one facility. Current laws and regulations will need to be modified to support new hospital standards and building codes. Appropriately distributed supplies and equipment could reduce fatigue and improve efficiency of nurses 29 by minimizing the time associated with finding supplies and equipment and moving from one location to another. Patients could benefit from more time with nurses and increased surveillance opportunities that require nurses to visually monitor patients—a benefit enhanced further by using single-bed rooms in hospital design.

Research over the past 10 years has compared single to semiprivate rooms and, in so doing, has provided greater insight into cost implications, patient satisfaction, and impact on patient care and outcomes.

Several reviews of the literature found that single-bed rooms were more conducive for infection control and patient care, 7 , 31 , 32 were associated with reduced stress and improved outcomes for patients, 33 and increased privacy and accessibility for patients and families.

In one study, patient satisfaction among low-risk maternity patients was found to be higher with single rooms because of having their privacy respected; patients felt they were in a comfortable environment and felt that they received more support and education.

Research in the early s found that unit efficiency was determined by the design of the unit, not room size or occupancy.

One study 51 began with a systematic evaluation of best practices in 19 intensive care units ICUs , built between and , that received a design award from the Society of Critical Care Medicine, the American Association of Critical Care Nurses, and the American Institute of Architects.

The reviewer found positive characteristics of the ICUs to include single-bed rooms for improved patient care, safety, privacy, and comfort; bed locations that provided easy access for clinicians; hand-washing sinks and waste disposal in the patient rooms; and use of natural lighting.

Negative characteristics were found to be renovation projects that posed health and safety hazards during the construction; mixed-service units with safety and staffing problems; overall layout—and layout of work areas for staff—that lacked a common design solution; and family space that was often located outside the unit and provided the family with limited access. Findings from the Pebble Project are expected to advance the evidence base by increasing our knowledge of design features that can ensure a safe healing environment where the best quality of care can be provided.

The project is intended to have a ripple effect and influence other health care facilities nationwide. Patient rooms are private and patients are in control of the temperature and light. Each room also has an interior window that can become opaque to increase privacy. The design also enabled nurses to observe patients better, resulting in half as many patient falls, and the need for patient transfers has decreased substantially from per month to an average of 20 per month.

Bronson Methodist Hospital in Michigan opened a new facility with private patient rooms and increased patient access to nature e. The Barbara Ann Karmanos Cancer Institute renovated several hospital areas to be patient-centered and to provide a more pleasant environment, where patient rooms were made larger and an emphasis was placed on lighting and acoustics.

In doing so, administrators and clinicians have seen a decrease in the use of pain medication and medication errors on these units. Thus, by incorporating private rooms into their designs, these four hospitals and patients they have served have experienced successful outcomes in their new and renovated facilities.

Two surveys intended to assess the work environment and challenges prior to moving forward with specific changes. Not only did nurses share similar concerns with parents, the facility aesthetics and work environment were found to be associated with higher satisfaction and better coworker relationships among nurses. Helpful characteristics of single-occupancy rooms were reported as: the more favorable layout of the room, including the availability of extra space in the room making arrangement of furniture easier and providing storage for clean and dirty supplies in the room; better privacy for patients and more space for family members; and better lighting and temperature control and lower noise levels.

A little over half of the respondents believed that health care acquired infections were low or very low in single-occupancy rooms, but that there was no difference in the number of patient falls or the need for pain-reducing or sleep-inducing medications between the two types of rooms.

Conversely, helpful characteristics of double-occupancy rooms included proximity to the nursing station.

However, being able to see patients for monitoring purposes was reported as problematic for both single and multiple occupancy rooms. Three studies assessed the perspectives of patients and family members in the United States and the United Kingdom. Patients and family members in the United States, across various settings, reported wanting a health care environment that facilitates connections to clinicians; fosters a sense of well-being; and is not dissociated from the world outside the hospital, outpatient setting, or long-term care setting.

For these patients, the most important factors about the built environment were privacy, a homely environment, considerations for disabilities, and being able to see outside and get outside.

In one study, there were fewer patients who left against medical advice, aggression levels in patients decreased, and levels of benzodiazepine dosing decreased compared to measured occurrences before the new unit opened.

Once in the new single-bed acuity-adaptable unit, researchers found: a large reduction in clinician handoffs and transfers; a 70 percent reduction in medication errors; a reduction in patient falls; improvements in patient satisfaction; decreases in budgeted nursing hours per patient day; and increases in available nursing time for direct care without additional cost. Designed ICU The implementation of a new neonatal intensive care unit, designed to have a more efficient floor plan, provide space for supportive family-centered care, and to use of natural light, used was assessed using multiple methods.

Nurses reported the new unit as enabling efficiency, in part attributable to being able to move about the unit at a greater velocity, enabling them to spend more time with the infants and less time needed to walk about the unit in the course of their work. The nurses also reported that the new unit was more comforting, clean and quieter, and the new lighting was thought to have a positive impact on the patients. Additionally, nurses reported that they felt that families were utilizing the majority of space designated to them.

Addressing the Problem: A Case Study One new bed community hospital in Wisconsin has been designed to improve patient safety through research-based design.

When it became apparent that St. The process began in April , when leadership from SynergyHealth St. The specific safety design principles, intended to specifically address both latent conditions and active failures, included the following: Automate where possible.

Design to prevent adverse events e. Design for scalability, adaptability, and flexibility. Place accessibility of information in close proximity to the patient. Improve visibility of patients to staff. Involve patients in their care. Minimize fatigue of staff. Reduce noise. The goal of this education was to gain commitment to the need for nurses to be active in the design phase. Then representatives of nursing were elected to a facility design committee.

Design teams of nurses were also formed to assure formal input into the design. Mock-ups were also an important feature and prompted more input from the nurses. Many rooms were mocked up, and the medical-surgical room was modified multiple times by the involvement of nurses reviewing every detail to assure a safe design. The interplay between the facility with its equipment and technology and nurses and patients creates safe or unsafe interactions, and the result is affected in large part by the facility design.

Once the National Learning Lab was over, St. For St. Not discounting the role of physicians, other clinicians, and health care staff, nurses provide care 24 hours a day, 7 days a week. As such, nurses providing care are most aware of the best way to design a patient room for example so the room design minimizes the potential for human error and harm to patients.

Single-Patient Room In many instances, including the need for patient isolation measures, double or multiple-occupancy rooms were viewed as not being conducive to patient safety and quality care. The floor plan shown in Figure 1 illustrates how a series of standardized single-patient rooms were laid out on both sides of a hallway in St.

This perspective allows various features of the room to be seen in relation to each other. There are two entrances to the room, one from the hallway along the lower edge of the picture , and one from the alcove on the right.

In that alcove, also entered from the hallway, a desk, computer, and chair are provided for use by staff. The alcove also contains a standardized storage area, so staff can find everything they need for the care of the patient adjacent to the patient room. The treatment area of the room is on the left side of the bed, with room all around the bed for patient care.

At the head of the bed is the headwall with connections for various gases such as oxygen; on the wall to the left of the bed is a pull-down table the caregiver can use when it is needed. Although it is not shown in the illustration, there will also be a portable cart in each room, with a computer on it. Last but not least, in the lower right-hand corner of the room, between the two doorways, easily visible to the patient, there is a sink—an ever-present and convenient reminder to nurses, all staff, and visitors to wash their hands.

Single-Patient Room in St. The patient room was selected as a good example of how the design plan for the hospital came together in one location. To show how the room design was reached, each of the applicable latent conditions and active failures will be discussed, to explain how they relate to the plan for a single-patient room. Noise reduction Noise interferes with communication, creates distractions, affects cognitive performance and concentration, and contributes to stress and fatigue.

In the traditional patient room style, called back-to-back, patient beds are on the same wall. Back-to-back plans create major transfer noise between rooms, and their use of the same oxygen, compressed room air, and suction intensifies the transfer noise and vibration.

In a truly standardized room, this does not occur. In addition, the walls between rooms are separated and insulated with airspace, minimizing transfer noise. This was designed into the structure early in the building design. In addition, vibration noise between floors and within a floor was minimized through design. The mechanical, electrical, and plumbing systems were designed to use the optimum materials for minimizing noise.

The flooring in the patient room is rubber, second to carpet in sound reduction qualities. The reason carpet was not chosen it was mocked up and tested is because spills and mishaps needed to be cleaned up immediately.

Carpet requires housekeeping to bring a carpet cleaner, which could take time and also could be embarrassing for the patient. Carpet was chosen, however, for the alcoves and hallways, with a low-nap, special carpet for hospital application.

Special ceiling tiles that absorb noise better than regular ceiling tiles were chosen. Triple glazed windows were specified to minimize outside noises. No overhead paging system is used except for public emergencies such as a tornado warning , and nurse call systems use minimal tone with vibrating features. As specific equipment and technologies were needed, manufacturers of that piece of equipment or technology were contacted and asked how they reduced noise in their products.

Scalability, adaptability, flexibility Many design and construction concepts can be applied to achieve a scalable e.

Health Facility Design Information Checklist

At St. Space around the bed is sized so procedures e. Visibility of patients to staff The importance of being able to see patients is inherent to nursing care, a concept that was recognized early by Florence Nightingale, who advocated the design of open, long hospital wards to see all patients. The design of units and patient rooms should allow caregivers to be in visual proximity to patients; a pod structure can allow close proximity and enable quality care by improving efficiency and effectiveness.

The nurse can also check on the patient in the evening without opening the door and waking the patient. Each room is wired for cameras for observation.

All materials, such as medication, linens, IV poles, and a rough-in for icemakers, are delivered to the alcove to allow nurses to spend more time with the patient. The chart will initially be in the room, but shortly after the new hospital opens, it will be replaced by electronic medical records with a workspace so nurses and other caregivers can spend more time with the patient. Furthermore, visibility also means lighting to see the patient. Natural light is maximized by large windows in every patient room.

Light sources after hours are as close to natural light as can be achieved cost effectively. Canned lights are located over the patient for assessment. A total of 15 lights are located in every room, including the bathroom and alcoves. Involving patients in their care The IOM 9 found that many patients have expressed frustration with their inability to participate in decisionmaking, to obtain information they need, to be heard, and to participate in systems of care that are responsive to their needs.

The availability of information for patients increases their knowledge regarding their illness and treatment options, and being informed gives patients the opportunity to participate in shared decisionmaking with clinicians and may help patients better articulate their individual views and preferences.

A couch folds outs into a bed; a desk with an Internet connection encourages family members or friends to stay with patients. This is intended to help patients to be more active with their care and better able to protect themselves from errors. A portable computer on a cart same one used by staff is located in each room so patients can have appropriate access to their chart.

Standardization Standardization has been documented as an important human factors-based design strategy 4 , 64 that can help lessen the number of errors.

Health Facilities

Standardization reduces reliance on short-term memory and allows those unfamiliar with a specific process or design to use it safely. The patient rooms in St. The headwalls are standardized throughout the facility; a seven-drawer configuration was designed into every patient room or alcove to provide consistency of supply locations and to simplify the restocking of those supplies. This provides staff with a known constant, regardless of where they may be caring for a patient throughout the facility due to floating, a patient resuscitation, or some other emergent situation.

The electronic medical record, use of bar-coding, computerized provider order entry, and other technologies will be standardized eventually, assisting in the development of standardized protocols and order sets.

The facility materials distribution and routine nurse functions can also be standardized to match the facility. Equipment is not fully standardized yet, but that is the goal, since fully standardized equipment provides the highest level of safety. The complexity and variety in equipment vendors and models is immense, and this complexity creates more errors. This weakness—the lack of equipment standardization—was pointed out continually in using failure and effects mode analysis.

So St. The hospital was able to purchase limited new patient monitoring equipment, and took care to assure that new and existing equipment were from the same vendor to give the user a similar feel and functionality, regardless of which equipment they were using.

The hospital will continue to utilize this process to guarantee long-term equipment standardization within the facility. Automation where possible The IOM identified health information technology solutions as a necessary component to improving patient safety.

These applications are intended to allow caregivers to give care more efficiently and rely less on short-term memory. Many design features and technology applications have affected multiple latent conditions. This was one of the important criteria used at the matrix exercise to determine which design features to include.Although it is not shown in the illustration, there will also be a portable cart in each room, with a computer on it.

Minimize fatigue of staff. The sketch is but a stepping stone in that process. Carpet was chosen, however, for the alcoves and hallways, with a low-nap, special carpet for hospital application. The greater the height you provide maybe up to 5. Especially in healthcare facility design, there is a dependence on the air-conditioning of indoor spaces rather than the usage of climatic and other natural processes to maintain the comfort conditions. The difference between an aggressively negotiated price and list price is considerable.

The private sector too is developing, aided by growth in health insurance and the industry per se is moving towards a market economy concept throwing up cafeteria choice for the consumer. Very frequently the major circulation paths through the hospital are laid out even before the tentative space allocation for the hospital departments is done. In our youth we had to baptize these models with drops of blood from accidentally cut fingers.

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